A University of Sydney study has shown that opioids offer older people with muscle and joint pain little benefit, whilst significantly increasing the risk of serious negative side effects.

Published in the Journal of Pain, the review focussed on the efficacy and safety of prescription opioids in older patients (60 years and older) with musculoskeletal pain across 24 international randomised controlled trials comparing the effects of opioids to placebo.

Opioids are one of the most common types of pain medication offered to patients with chronic knee, hip or low back pain in Australia in recent decades. The increased rate of opioid use is raising concerns about the safety of these medicines and the risk of overuse and opioid-related adverse events.

“Chronic musculoskeletal pain including knee, hip or low back pain, is the main reason for taking pain medication among older people,” said author Associate Professor Manuela Ferreira, senior researcher at the Institute of Bone and Joint Research, Kolling Institute and University of Sydney.

“Our findings show that in this group opioid painkillers have only a small effect on decreasing pain and improving function, whilst the risk of side effects is high.

“Patients experienced around a seven percent decrease in pain compared to placebo pills, which is considered too small to be of clinical importance. Only small improvements in physical function were found.

“We also found that older people taking opioids for musculoskeletal pain are almost three times more likely to have an adverse event associated with treatment. The most common being nausea, constipation, drowsiness, dizziness, headache and dry mouth.

“The impact of these side effects on the older patient can be very significant, leading to more serious events such as falls and confusion.”

The review showed that the benefits and risks of opioids were the same, even when the lower daily dose was compared to higher doses.

“There is a big push currently to decrease the prescription and use of opioids in Australia and overseas,” Associate Professor Ferreira said.

“For this specific population, the benefits may not compensate for the risks that opioids can cause. Other treatments for chronic pain that have a lower risk of side effects such as exercise and physical therapies should be considered.

“Concerns about the safety of these medicines and the risk of overuse and opioid-related adverse events should also be considered by doctors when prescribing those medicines.